Mod/Ex/Aging/Research SAEs Flashcards

Question

77. Which factor is associated with increased risk for occupational injury in an older individual? (a) White collar occupation (b) Female gender (c) Impaired hearing (d) Self employment

Answer 1

Answer: C Commentary: Predictors of increased injury risk in an older worker include male gender, less education, obesity, alcohol abuse, disability, self report of impaired hearing or sight, and several specific job requirements. Service workers, mechanics, machine operators, and laborers are at increased risk for occupational injury compared to people in white collar occupations. Individuals who are self-employed have a lower risk of injury.

Answer 2

Answer: B Commentary: If a publicly accessible office is present within a single family home, it is required to be accessible under the ADA, so long as the necessary modifications are readily achievable. Accessibility of commercial airplanes is covered under the Air Carrier Access Act, not the ADA. Access to houses of worship or strictly residential private apartments is not required under the ADA.

Answer 3

Answer: D Commentary: Muscle force generation varies depending on the type of muscle contraction and the speed of the contraction. Eccentric contractions produce greater torque than isometric contractions and isometric contractions produce greater force than concentric muscle contractions. As the speed of contraction increases, eccentric contractions produce greater force. The opposite is true for concentric contractions, which generate greater forces at slower speeds.

Answer 4

Answer: A Commentary: Conduction is a process of transferring thermal energy between 2 entities placed in direct contact with each other, for example cold packs on skin. Convection is a process of using a medium to transfer energy: Examples of convection include the use of husks with fluidotherapy, and the use of water with whirlpool therapy. Vapocoolant sprays are an example of evaporation, not conduction.

Answer 5

Answer: A Commentary: The Americans with Disabilities Act defines disability as a physical or mental impairment that substantially limits 1 or more of a person’s major life activities. The person has a record of such impairment, or is regarded as having such impairment. Impairment is the actual physiologic, anatomic, or psychologic abnormality. Handicap refers to the barriers society places on an individual to perform function in the community. A permanent disability rating is used to determine financial compensation for an injury.

Answer 6

Answer: A Commentary: Palliative care involves a holistic approach to comprehensive symptom management. This care has a potential role in the management of all disease states that feature an intense and adverse symptom complex. Palliative care typically does not include disease modifying therapies, although it can be provided in conjunction with these treatments. Palliative care can be provided in a variety of health care settings and is not limited to persons with terminal illnesses.

Answer 7

Answer: C Commentary: In terms of continuous quality improvement, a sentinel event is defined as a single occurrence that is highly problematic or socially unacceptable. Sentinel events will typically trigger an in-depth root cause analysis to determine the cause of the event as well as potential solutions. The focus of these investigations is to evaluate the processes and systems that are in place rather than to focus blame on individual practitioners.

Answer 8

Answer: B Commentary: The validity of a functional outcome measurement tool is defined as the ability of the tool to measure what it is designed to measure. The ability to measure different outcomes simultaneously does not impact the validity of the instrument, but the validity of the tool would need to be established for each of the outcomes being measured. The ability of two different raters to obtain the same conclusion is referred to as inter-rater reliability. Freedom from random error is also related to the reliability of the instrument.

Answer 9

Answer: C Commentary: There are 2 primary muscle fiber types in humans. They are categorized according to speed of contraction and sources of fuel. Type 1 muscle fibers are slow-twitch with oxidative metabolic pathways. Type 2 muscle fibers are fast-twitch fibers. The type 2 fibers can then be further divided into fast-twitch with both oxidative and glycolytic metabolism (type 2a) and fast-twitch glycolytic (type 2b).

Answer 10

Answer: D Commentary: The weight for cervical traction is most beneficial at 25 to 35 pounds of force. Positioning the neck at 20o to30o of flexion provides the maximal effect of distraction between the vertebrae.

Answer 11

Answer: B Commentary: Experimental research designs enable investigators to determine a cause and effect relationship between 2 variables; whereas, non-experimental research designs can only establish an association between 2 variables. In an experimental research design an intervention or experimental variable is manipulated and its effect on other variables is measured. Experimental designs are prospective in nature. Cohort studies, in which researchers observe the natural history of a disease process, are non-experimental.

Answer 12

Answer: B Commentary: The appropriate descriptive statistical method used to summarize ordinal data such as the values used in the Modified Ashworth Scale is the median. The median value is defined as the value that occurs in the middle of a set of values. The mean would be used to summarize ratio or interval type of data. The other options listed are not descriptive statistical measures.

Answer 13

Answer: C Commentary: Informed consent documents for participation in research protocols must include the procedures to be used in the study. Informed consent documents must also assure confidentiality of the subjects and outcomes of individuals participating in the research. Informed consent documents must also state that subjects have the right to terminate involvement in the study at any time, even after they have signed the consent document. It must also state that the decision to terminate involvement in the study will not affect the individual’s ongoing medical care. Informed consent documents do not provide information that research results will be shared with the individual subjects.

Answer 14

Answer: B Commentary: Petrissage is a method of compression massage that is used to break up tissue and muscle adhesions. In effleurage massage the practitioner uses a stroking motion that is beneficial for vascular and lymphatic drainage. Friction massage is a method of massage that uses circular motions to small areas of tissue to help with tendonitis and fasciitis. Acupressure is a massage method in which pressure is applied on specific body points to help reduce pain.

Answer 15

Answer: B Commentary: Cryotherapy and heating modalities share several therapeutic benefits and therapeutic contraindications. Both heat and cold modalities have some analgesic properties and can be used as adjuvant treatments for pain management. Neither cold nor heat modalities should be used over insensate areas or over areas with decreased vascular supply. Heat modalities may increase edema in the area treated, whereas cold therapy will not lead to increased edema.

Answer 16

Answer: D Commentary: Conversion is a process of transforming energy to heat; for example, sound transformation with ultrasound. Conduction is a transfer of thermal energy through direct contact; for example, hot packs. Convection is a process of using a medium to transfer energy; for example, fluidotherapy. Evaporation is a process of transforming a liquid to a gas; for example, vapocoolant sprays.

Answer 17

Answer: A Commentary: According to the AMA Code of Ethics Opinion, individual gifts of minimal value from pharmaceutical representatives to physicians are permissible, so long as the gifts are related to the physician's work. It is not acceptable for physicians to request free pharmaceuticals for personal use or use by family members. Subsidies to underwrite the costs of continuing medical education are permissible when they are accepted by the conference's sponsor and are not provided directly to the physician. It is acceptable for faculty at conferences to accept reasonable honoraria and reimbursement for travel, lodging, and meal expenses.

Answer 18

Answer: D Commentary: A clinical trial can best be defined as a prospective study comparing the effect and value of an intervention with a control. A study measuring the natural history of a disease process is more observational in nature and can be either prospective or retrospective. Clinical trials are not necessarily randomized or double-blinded. Clinical trials are prospective and not retrospective in nature.

Answer 19

Answer: B Commentary: A benchmark is a target value or standard for comparison for a performance indicator. Functional outcomes and efficiency of functional improvement during inpatient rehabilitation admission are examples of performance indicators. The UDS-FIM database provides a means by which individual rehabilitation units can compare their outcomes to other centers across the nation. This process of comparing outcomes to a standard is referred to as benchmarking.

Answer 20

Answer: C Commentary: The physician should be concerned if there is a time gap between the ultrasound application and the stretching activity. In order to be effective, the deep heating that is accomplished with the ultrasound application should be combined with a period of prolonged passive stretching, both during and immediately after the ultrasound application. This can be achieved by having the patient stand during the ultrasound application and after it. An appropriate treatment time with ultrasound is 8 to 12 minutes and the patient may experience a transient deep ache in the treatment application area.

Answer 21

Answer: C Commentary: Continuous quality improvement should be a part of each physician's clinical practice. All of the options listed would be appropriate to consider, with the exception of immediately ordering a urine culture on every patient at the time of admission to the rehabilitation service. This option would not be appropriate without gathering more information and understanding the implications of this intervention strategy.

Answer 22

Answer: B Commentary: The Functional Independence Measure (FIM) is an outcomes measurement tool used by inpatient rehabilitation facilities across the country. It enables inpatient rehabilitation programs to compare their patients’ outcomes with regional and national outcomes. The FIM measures an individual’s functional abilities and level of assistance required in 18 separate functional areas, including cognition and communication. The FIM instrument uses a 7-point scale to rate the amount of assistance that an individual requires in each of these functional areas. The FIM can be completed at any frequency, but is typically completed at least at the time of admission and at the time of discharge from an inpatient rehabilitation facility.

Answer 23

(b) While more than 2 patient identifiers may be used, a minimum of 2 is required: first, a marker to identify the individual as the person for whom the service or treatment is intended; second, an identifier to match the service or treatment to that individual.

Answer 24

(c)The only listed expression that may be written on a prescription is 2 mg for 2 milligrams. JCAHO expects that the other abbreviations will not be used in writing drug prescriptions, since they can lead to errors. Davis' Medical Abbreviations cites U as "the most dangerous abbreviation" and says spell out "unit." The expression QD is too easily read as 4 times daily. Regarding MSO4, Davis also calls this as "a dangerous abbreviation."

Answer 25

(d) TENS therapy has not been shown to provide benefit for angina. It has been proven to have a beneficial effect in all the other diagnoses.

Answer 26

(c) Cervical traction is proven effective for illnesses that involve nerve root irritation or compression of nerve roots.

Answer 27

(a) A person who knowingly discloses individually identifiable health information in violation of HIPAA faces a fine of $50,000 and up to a 1-year imprisonment. The criminal penalties increase to $100,000 and up to 5 years imprisonment if the wrongful conduct involves false pretenses, and to $250,000 and up to 10 years imprisonment if the wrongful conduct involves the intent to sell, transfer, or use individually identifiable health information for commercial advantage, personal gain, or malicious harm.

Answer 28

(a) Informed consent for participation in a research study requires that the risks be described in terms of type, severity, and probability. It is important to describe risks in each of these areas in order to fully inform the patient of the potential risks associated with study participation.

Answer 29

(c) Protected Health Information includes individually identifiable health information. This is information, including demographic data, that relates to any of the following particulars: the individual’s past, present or future physical or mental health or condition; the provision of health care to the individual; or the past, present, or future payment for the provision of health care to the individual. It can also be information that identifies the individual or for which there is a reasonable basis to believe it can be used to identify the individual. Individually identifiable health information includes many common identifiers (e.g., name, address, birth date, Social Security Number).

Answer 30

(c) The principle of justice requires subjects to be treated fairly and selected equitably. The principle of beneficence ensures that researchers minimize harm and maximize benefits associated with research involvement. The principle of autonomy ensures that informed consent includes full disclosure of risks and benefits and that the privacy of subjects is respected.

Answer 31

(a) Type 1 (alpha) error is best described as occurring in research when the study finds a positive benefit from the intervention, but no benefit really exists. In this case, the study conclusions would be falsely positive.

Answer 32

(d) Significant evidence exists to show that elderly persons benefit from strength training. In the past it was believed that adaptations were due to only neural factors. Recent evidence has shown that strength gains in elderly persons are attributable to both neural factors and muscle hypertrophy.

Answer 33

(b) Sustained traction is the use of force greater than that applied in continuous traction, but less than that used in intermittent traction, and the application time is 20--60 minutes. This time frame makes sustained traction more practical in clinical use. Continuous traction is the use of low force of traction over long periods of time, 20--40 hours. Intermittent traction is the use of greater forces, but for shorter periods of time, 10--60 seconds. There is no pulsed traction.

Answer 34

(b) FIM scores would be classified as ordinal data, because in an ordinal scale consecutive values are rank-ordered, but not equally spaced. For example, although there is an order to the ranking in the FIM scale, the difference between a 2 and a 3 may not be equal to the difference between a 6 and a 7. Nominal data refers to data with discrete values (yes/no; alive/dead). With interval data, there are equal intervals between consecutive values. An example of interval data is temperature in degrees Fahrenheit. Ratio data are interval data with equal intervals between consecutive values, but with an absolute zero point.

Answer 35

(d) The process of developing and adopting quality standards for clinical practice helps to form expectations for safety among both providers and consumers.

Answer 36

(d) Evaporation is a process of transforming a liquid into a gas and requires thermal energy, as in vapocoolant spray. Convection is a process of using a medium to transport energy, for example husks during fluidotherapy and water during whirlpool therapy. Conduction is a process of transferring thermal energy to bodies that are in direct contact, for instance cold packs applied to skin. Conversion is a process of transforming energy into heat, as occurs with an ultrasound device.

Answer 37

(b) Low frequency electrical stimulation predominantly stimulates type 1 muscle fibers. High frequency electrical stimulation predominantly stimulates Type 2 muscle fibers. There are no type 3 muscle fibers.

Answer 38

(a) Iontophoresis is the migration of charged particles across biological membranes under an imposed electrical field. Phonophoresis is the use of ultrasound to facilitate transdermal migration of topically administered medications. Ultrasound is a type of heating that occurs as a result of acoustic vibration. Laser therapy is light amplification by stimulated emission of radiation. It consists of a coherent, collimated beam of photons of identical frequency.

Answer 39

(a) The primary benefit of quality outcomes management is that it provides guidance for aligning the program with the needs of the patient. None of the other options are benefits of quality outcomes management.

Answer 40

(d) The prospective payment system for inpatient rehabilitation facilities requires that all patients admitted for inpatient rehabilitation be assigned to an impairment group code category. Payment to the rehabilitation facility is further determined by the patient’s subclassification into a case-mix group. The FIM instrument motor score is used to help determine the case-mix group designation under the prospective payment system for inpatient rehabilitation facilities. None of the other options listed are used in this process.

Answer 41

(a) The interdisciplinary approach to patient care emphasizes common patient and team goals rather than discipline-specific goals. The patient and family members should be included in the goal setting process. All team members must work in a collaborative way to facilitate achievement of goals. Team members must have an appreciation for all the issues that affect the patient rather than focusing on an isolated problem. Team communication is essential at all points in the rehabilitation process, not just when problems occur. Stewart DG, Phillips EM, Bodenheimer CF, Cifu DX. Geriatric Rehabilitation. 2. Physiatric approach to the older adult. Arch Phys Med Rehabil 2004; 85(Suppl 3):S7-11.

Answer 42

(b) Case managers are shown to be beneficial liaisons between the physician and workers compensation carrier and their presence facilitates patient care. To be treated as a workers compensation case, the patient must give the carrier full access to his/her medical record. The employee treated under workers compensation cannot restrict the access of the case manager to the physician; however, discussions with the case manger should be done in the environment that the patient requests. Nadler SF, Stitik T, Malanga GA. Optimizing outcome in the injured worker with low back pain. Crit Rev Phys Med Rehabil Med 1999;11:139-69.

Answer 43

(a) The purpose of the Health Insurance Portability and Accountability Act (HIPAA) is to ensure that a patient’s medical record remains private, but is available to health care providers as directed by the patient. A non-treating physician, lawyer, or insurance company may have access to the record with written authorization by the patient or guardian. There are no stipulations about a physician’s qualifications with regards to medical information access

Answer 44

(d) In order to appropriately follow Medicare regulations for teaching physicians, when caring for a patient with a resident physician, the attending physician must see the patient, review the medical record documentation of the resident, and personally document involvement in key aspects of the history, exam, and medical decision-making. Documentation from the resident alone does not confirm the level of attending physician involvement. The attending physician documentation combined with the resident documentation can be used to determine the level of care provided and the appropriate level of billing.

Answer 45

(b) Humans have 2 primary types of muscle fiber. They are divided according to many different characteristics, including speed of contraction and sources of fuel. Type 1 muscle fibers are slow-twitch with oxidative metabolic pathways. Type 2 muscle fibers are fast-twitch fibers. The type 2 fibers can then be further divided into fast-twitch oxidative (type 2a) and fast-twitch glyclolytic (type 2b).

Answer 46

(c) An advantage of a single-subject research design (A-B-A design) is that this design can establish cause and effect relationships similar to other true experimental designs. Single subject research designs involve systematic, repeated measurement of a dependent variable over time through 1 or more baseline and intervention phases. The primary limitation with a single-subject research design is that it only establishes the cause and effect relationship for the subject involved in the study. Therefore, these results cannot be assumed to occur in others, because of the variability between subjects. Typically, a single subject research design requires a washout period between medication trials to ensure that the effects of the medication are no longer active. Single subject research designs are especially useful for interventions that do not have extended or prolonged effects. If the intervention has only short-term effects, then a difference in the outcome measured can be clearly demonstrated by comparing results when the intervention is in use against results obtained when it has been removed.

Answer 47

(d) Prolonged bed rest has detrimental effects, which include an increased resting heart rate, loss of plasma volume, decreased cardiac stroke volume, and decreased maximum oxygen consumption. Buschbacher RM, Porter CD. Deconditioning, conditioning, and the benefits of exercise.

Answer 48

(b) Open kinetic chain exercise occurs when the most distal segment is not in contact with a surface (eg, leg extensions). Closed kinetic chain exercise occurs when the most distal segment is in contact with a surface (eg, a leg press). In isokinetic exercise a muscle contracts with a constant angular velocity and variable resistance. In isometric exercise a muscle contracts against an immovable object and there is no joint angular movement. Young J, Olsen N, Press J. Musculoskeletal disorders of the lower limbs.

Answer 49

(a) According to the Charter on Medical Professionalism, there are 3 fundamental principles of medical professionalism. They are (1) the primacy of patient welfare, (2) patient autonomy, and (3) social justice.

Answer 50

(d) Preventable medical errors can result in lower levels of patient satisfaction and loss of trust in the health care system. Preventable medical errors often result in significant morbidity and even mortality. Estimates are that 44,000 to 98,000 people die each year as a result of medical errors that could have been prevented. These errors are frequently the result of system type errors rather than individual human error.

Answer 51

(b) When critically evaluating the medical literature, it is important to consider if the results of the study are both clinically and statistically significant. It is also important to consider whether the outcome assessment tools have been validated for both accuracy and reliability. While biases that may impact the outcome of the study also must be considered, it is often impossible to completely eliminate bias from the study.

Answer 52

(b) Ultrasound is typically an inexpensive treatment that may help with pain and bone maturation, however, it is contraindicated near arthroplasties and therefore not a good treatment in this case. Further contraindications include use of ultrasound: near pacemaker, near spine or laminectomy site, near brain, eyes, or reproductive organs, is someone with malignancy or skeletal immaturity, or near sites where methyl methacrylate was applied

Answer 53

(b) Paraffin bath use has many methods. The dipping method increases subcutaneous temperatures by 3o Celsius, and the intra-articular temperature by 1o Celsius. The continuous method increases the subcutaneous temperature by 5o Celsius and the intramuscular area by 3º Celsius. The paint on method heats the subcutaneous area less than the dipping method. There is no formal wrap method. Basford JR. Therapeutic physical agents.

Answer 54

(A) meta-analysis summarizes the results of randomized controlled trials on a particular topic or research question. A consensus statement summarizes the findings of an expert panel. In developing a consensus statement and reviewing the literature, research studies are typically divided into 3 tiers based on the type of research performed. A multi-center study implements a particular research protocol at multiple centers at different institutions.

Answer 55

(d) All of the options listed are key aspects of practice-based learning and improvement, with the exception of the ability to advocate for quality patient care and assist patients in dealing with system complexities. This statement is a key aspect of systems-based practice as defined by the Accreditation Council of Graduate Medical Education

Answer 56

(c) The Commission on Accreditation of Rehabilitation Facilities (CARF) provides accreditation status that signifies the rehabilitation facility holds itself to the highest standards in the field. CARF accreditation is voluntary and not all inpatient rehabilitation facilities participate. Accreditation by CARF does not confer any preferred status with payors, and CARF provides accreditation in general comprehensive inpatient rehabilitation as well as specialty programs such as spinal cord injury and traumatic brain injury

Answer 57

(b) Beneficence requires investigators to design protocols that will provide generalizable knowledge and ensure that the benefits of the research are proportionate to the risks assumed by the subjects.

Answer 58

(d) Conflicts of interest in biomedical research are becoming more apparent as private companies increasingly develop relationships with academic research scientists. Avoidance of real or perceived conflicts of interest in clinical research is necessary if the medical community is to ensure objectivity and maintain individual and institutional integrity. Financial investments should only transpire outside of the time that the investigator is involved in any research activity and the results of the research are known to the public. If conflicts of interest exist, the investigator is obligated to disclose this involvement in writing to the investigator's medical center, organizations funding the research, and anytime that the research is presented or published.

Answer 59

(d) Exercise should be at 60% to 85% of predicted maximum heart rate. Pregnant women should not exercise to exhaustion. Exercise should be done 3 to 4 days a week for 30 to 45 minutes at a time. Pregnant women should avoid exercise in the supine position because such a position may decrease cardiac output, resulting in blood diverting from the splanchnic beds (including the uterus).

Answer 60

(a) The Center for Medicare and Medicaid Services currently reimburses inpatient rehabilitation facilities (IRF) based on a prospective payment system (PPS) according to the patient’s severity of disability and his/her required use of resources. The rehabilitation impairment category is based on the primary rehabilitation diagnosis, and the case-mix group is determined in part by the patient’s co-morbid medical conditions. (a) Johnston MV, Eastwood E, Wilkerson DL, Anderson L, Alves A. Systematically assessing and improving the quality and outcomes of medical rehabilitation programs.

Answer 61

(d) Medical error reporting systems are designed to encourage staff to report sentinel events, adverse events, and close calls without fear of punishment. If these issues are recognized, then further review and action can be initiated. Review may include a root cause analysis to determine the exact cause of the problem and strategies for prevention. When a medical error has occurred, staff are encouraged to recognize the issue and report the issue immediately. Johnston MV, Eastwood E, Wilkerson DL, Anderson L, Alves A. Systematically assessing and improving the quality and outcomes of medical rehabilitation programs

Answer 62

(c) The husband is the patient’s legal next-of-kin. Because the patient is unable to provide consent for medical decision making, the husband is the primary contact person and has the medical power of attorney for medical decision making. The husband would have to consent to allow other individuals to receive medical information regarding the patient. United States Department of Health and Human Services.

Answer 63

(a) Deterioration in personal hygiene is the most likely warning sign of substance abuse in a resident colleague. Other warning signs of impairment secondary to substance abuse include increased rates of absenteeism, inability to meet deadlines, loss of concern about patient welfare, and wide fluctuations in mood and performance.

Answer 64

(d) Convection is a process of using a medium to transport energy: husks, for example, with fluidotherapy, and water with whirlpool therapy. Conduction is a process of transferring thermal energy between 2 entities placed in direct contact with each other: cold packs on skin or, vapocoolant spray on skin or cold water immersion of a limb.

Answer 65

(d) Federal research regulations stipulate that each institutional research review board (IRB) is responsible for approving all research studies at their particular institution. Before approving a research protocol, the IRB must determine that risks are minimized, selection of subjects is equitable, protections for privacy and confidentiality are in place, informed consent is appropriate and will be documented in writing, and that the study has plans for data monitoring where appropriate. Research may involve subjects who are considered vulnerable, such as prisioners, but the research must add extra protections for these subjects.

Answer 66

(d) Once a physician is certified by the American Board of Physical Medicine and Rehabilitation, he or she must continue to fulfill certain requirements in order to maintain certification status. Publication of an article in a peer-reviewed journal every 10 years is not a requirement for maintenance of certification. All the other options listed are required.

Answer 67

(c) Central to determining an individual's decision-making capacity are the individual's ability to express a choice, his/her ability to understand specific information related to treatment decisions, and his/her ability to appreciate the significance of information as it applies to their condition and circumstances. The individual's ability to seek advice from other health care providers is not a central part of the individual's decision-making capacity.

Answer 68

(c) Continuous quality improvement should be a part of each physician's clinical practice. All the options listed would be appropriate to consider with the exception of immediately ordering a urine culture on every patient at the time of admission to the rehabilitation service. This would not be an appropriate option without gathering more information and understanding the implications of this intervention strategy.

Answer 69

(a) The Commission on Accreditation of Rehabilitation Facilities (CARF) defines program evaluation as a systematic procedure for measuring the outcomes of care. Program evaluation is a way to measure the effectiveness and efficiency of rehabilitation services. The other options listed are not the primary focus of program evaluation.

Answer 70

(c) Ultrasound uses high frequency acoustic energy to produce its effects. Fluidotherapy is superficial dry heat using convection with forced hot air and a bed of finely divided particles. Microwave heat occurs when thermal energy is produced by increasing the kinetic energy of molecules within the microwave field, thus using the mechanism of conversion. Short wave diathermy is the conversion of electromagnetic energy into thermal energy when the osscillation of high frequency electrical and magnetic fields produces molecular movement and heat

Answer 71

(d) The type of massage described in the question is effleurage. The other options are different forms of massage therapy techniques: (1) friction, pressure is applied with the ball of the practitioner’s thumb or fingers to the patient’s skin or muscle; (2) petrissage, compressing the skin and soft tissue between the fingers and thumb of one hand; and (3) tapotement, striking the soft tissue with repetitive blows using both hands in a rhythmic manner

Answer 72

(c) Maintaining confidentiality of patient information is important even when discussing health information with family members. Before discussing the patient's health status with his son, the appropriate first step would be to ask the patient for permission. The other options listed would not be appropriate initial management strategies. United States Department of Health and Human Services

Answer 73

(c) In terms of continuous quality improvement, a sentinel event is defined as a single occurrence that is highly problematic or socially unacceptable. Sentinel events will typically trigger an in-depth root cause analysis to determine the cause of the event as well as potential solutions. The focus of these investigations is to evaluate the processes and systems that are in place, rather than to focus blame on individual practitioners. Johnston MV, Maney M, Wilkerson DL. Systematically assuring and improving the quality and outcomes of medical rehabilitation programs.

Answer 74

(c) The Omnibus Budget Reconciliation Act of 1993 (Stark II legislation) made physician self-referral to physical therapy, durable medical equipment suppliers, and certain other entities owned by the physician illegal, except for certain safe harbors. Gnatz SM. Administration and management in Physical Medicine and Rehabilitation.

Answer 75

(d) A clinical trial can best be defined as a prospective study that compares the effect and value of an intervention with a control. A study measuring the natural history of a disease process is more observational in nature and can be either prospective or retrospective. Clinical trials are not necessarily randomized or double-blinded. Clinical trials are prospective and not retrospective in nature.

Answer 76

(b) The ethical principle in this case, where the physician concedes to the patient’s desires and decisions, is the principle of patient autonomy. The principle of beneficence refers to a moral obligation to help other people and refrain from harming them, while the principle of autonomy involves respect for the values and beliefs of other people. There is often tension between these 2 principles when patients refuse to accept information and advice from their health care providers. With a paternalistic approach, the physician or other health care provider is the decision maker and the patient takes on a more passive role of accepting the decision of the health care provider. Social justice involves the provision, rationing, and distribution of health care resources.

Answer 77

(a) The purpose of the Health Insurance Portability and Accountability Act (HIPAA) is to ensure that a patient’s medical record remains private. A non-treating physician, lawyer, insurance company, etc. can have access so long as the patient directs it, with written authorization. There are no stipulations about a physician’s qualifications with regards to medical information access. Office for Civil Rights–HIPAA Privacy: incidental uses and disclosures.

Answer 78

(d) The Americans with Disabilities Act (ADA) provides that workers with disabilities be offered equal access in the work environment. The Act requires the employer to provide accessible environment for the workers. Dimensions for doorways, hallways, ramps and elevator lifts are specified to allow 2 of 11 wheelchair access. The ADA does not make stipulations with regards to pay, or that an employer is forced to hire a disabled worker. The ADA does not make any determinations regarding a disabled person’s ability to work.

Answer 79

(c) Case managers reduce workers’ compensation costs by 23% and reduce the overall number of lost-time cases. Overall case management can help improve the quality of care, reduce cost, and decrease time loss in the worker’s compensation system. Studies show that case managers doe not interfere with the physician-patient relationship or the physician’s recommendations, and do not make proposals that favor the insurer. (a) Bernacki EJ, Tsai SP. Managed care for workers’ compensation: three years of experience in an “employee choice” state.

Answer 80

(a) Narcotics and non-narcotic medications often may be necessary to manage pain in the injured worker. It is important to set expectations of how these medications will be used. Expected length of time of narcotic usage is especially important. The goal should be to return the worker to his/her job without medication. Simply cutting off medications may be inappropriate. As pain improves, and strength and function improve, medications should be tapered. (a) Foye PM, Stitik TP, Marquardt CA, Cianca JC, Prather H. Industrial medicine and acute musculoskeletal rehabilitation.

Answer 81

(d) By Medicare guidelines, to obtain a semi-electric hospital bed for a patient the physician must complete a certificate of medical necessity. Although a full electric bed used in most hospitals may 8 of 11 be beneficial for many patients, Medicare guidelines consider the electric powered, variable height feature a convenience and, therefore, Medicare will not cover a full electric bed. A semi-electric hospital bed will be covered if the patient requires frequent changes in body position or has an immediate need for change in body position along with at least 1 of the following conditions: (1) The patient requires positioning of the body in ways not feasible with an ordinary bed. (2) For pain relief, the patient requires positioning of the body in ways not feasible in an ordinary bed. (3) Because of congestive heart failure, pulmonary disease, or aspiration, the patient requires the head of the bed to be elevated more than 30° most of the time. (4) The patient requires traction equipment that can only be attached to a hospital bed. The standard hospital bed has many disadvantages. The beds have a 10-inch excursion from a low of 24 inches to a high of 34 inches. Additionally, the standard hospital bed frame has a weight limitation of around 500 pounds.

Answer 82

(b) Evidence-based medicine does not include the development of strict standards of care for clinical practice. Instead, evidence-based medicine emphasizes the conscientious and explicit use of the current best evidence in making decisions about the care of individual patients. Integrating individual clinical expertise with the best available clinical evidence from systematic research and life-long, self-directed learning in which caring for patients creates the need for clinically important information are also part of evidence-based medicin

Answer 83

(b) When performing manual medicine, or when referring a patient to a physician for manual medicine, one must be acutely aware of what contraindications apply to the individual one is treating. The absolute contraindication to high velocity low amplitude among the options listed is osteomyelitis

Answer 84

(d) Paraffin has a lower thermal conductivity than water, which allows it to be placed on the skin at a higher temperature without causing injury to the skin. The heat is more slowly transferred from the paraffin to the skin, which provides for heating over a longer period of time.

Answer 85

(d) Federal research regulations stipulate that each institutional research review board (IRB) is responsible for approving all research studies at their particular institution. Before approving a research protocol, the IRB must determine that risks are minimized, selection of subjects is equitable, protections for privacy and confidentiality are in place, informed consent is appropriate and will be documented in writing, and that the study has plans for data monitoring where appropriate. Research may involve subjects who are considered vulnerable, such as prisoners, but the research must add extra protections for these subjects.

Answer 86

(d) Once an individual becomes board certified in the specialty of physical medicine and rehabilitation, he/she must continue to fulfill certain requirements in order to maintain their certification status. Publication of 1 article in a peer-reviewed journal every 10 years is not a requirement for maintenance of certification. All of the other options listed are required.

Answer 87

(a) Experimental research designs allow researchers to determine a cause-and-effect relationship between 2 variables, whereas non-experimental research designs are only able to establish an association between 2 variables. In experimental research an intervention or experimental variable can be manipulated, and its effect on other variables can be measured. Experimental designs are prospective in nature. Cohort studies that focus on observation of the natural history of a disease process are non-experimental.

Answer 88

(a) Ultrasound should not be used near a pacemaker, near a spinal laminectomy site, near brain, eyes, or reproductive organs, near a malignancy, in areas of skeletal immaturity, or ear arthroplasties, especially in persons using methyl methacrylate

Answer 89

(c) Decision-making capacity is a requirement for providing informed consent and having a patient participates in treatment decisions. Central to determining an individual's capacity for making decisions is his/her ability to express a choice, ability to understand specific information related to treatment decisions, and ability to appreciate the significance of information as it applies to his/her condition and circumstances. The individual's ability to seek advice from other health care providers is not a central part of the individual's decision-making capacity.

Answer 90

(a) The Commission on Accreditation of Rehabilitation Facilities (CARF) defines program evaluation as a systematic procedure for measuring the outcomes of care. Program evaluation is 1 method to measure the effectiveness and efficiency of rehabilitation services. The other options listed are not the primary focus of program evaluation.

Answer 91

(c) Maintaining confidentiality of patient information is important even when discussing health information with family members. Before discussing the patient's health status with his son, the appropriate first step would be to ask the patient for permission. The other options listed would not be appropriate initial management strategies.

Answer 92

(c) The most effective use of ice for pain control in osteoarthritis is application of ice for 20- to 30- minute periods. The ice should not touch the skin, but wrapped in a protective layer or towel to prevent damage to the skin. It should rest over the joint and not be moved around. Frequency should be on an as needed basis, but there should be at least a 30-minute break between sessions.

Answer 93

(a) Acupuncture is considered to help reduce pain through neuromodulation. The 2 theories of neuromodulation with acupuncture are (1) stimulation of large sensory afferent fibers suppress pain perception through gate control and (2) the needle insertion may act as a noxious stimulus and induce endogenous production of opiatelike substances

Answer 94

(b) The ethical principle demonstrated in this case in which the physician concedes to the patient’s desires and decisions is the principle of patient autonomy. The principle of beneficence refers to a moral obligation to help other people and to refrain from harming them. Inherent in the principle of autonomy is respect for the values and beliefs of other people. There is often tension between these 2 principles when patients refuse to accept information and advice from their health care providers. With a paternalistic approach, the physician or other health care provider is the decision maker and the patient takes on a more passive role of accepting his/her decisions. Social justice refers to the provision, rationing, and distribution of health care resources.

Answer 95

(b) During vigorous exercise, sympathetically mediated vasoconstriction occurs in the skin and viscera. Vasodilatation in active muscle groups is mediated by local factors including potassium ion concentrations, increases in osmolarity, changes in adenosine nucleotide concentrations, and decreasing pH. Muscle blood flow may increase up to 15-20 times baseline. The vasodilatation in muscle groups causes a reduction in total peripheral resistance by up to 50%.

Answer 96

(b) Patients with rheumatoid arthritis have ligamentous instability. This can lead to subluxation of cervical vertebrae, especially at the atlantoaxial joint (C1-2). Because instability can lead to spinal cord compression, cervical traction is, therefore, absolutely contraindicated in persons with rheumatoid arthritis. The best angle of pull is between 20° and 30° of flexion. The most common reason for cervical traction to fail or to exacerbate symptoms is applying the force in extension rather than in flexion. The home traction unit should always be placed so the patient is facing toward the door to which the pulley is attached. At least 10 pounds of force is needed to counter the effects of gravity on the head. To straighten the cervical lordotic curve requires 25 pounds of force.

Answer 97

(b) A functional capacity evaluation (FCE) is an assessment of a worker’s ability to perform workrelated activities. A functional capacity examination can be used to determine if a worker might benefit from work hardening or work conditioning, to determine whether a worker can return to his/her job, to determine if work restrictions are recommended or if job modifications are needed, and to document the worker’s activity capability. No absolute time line exists. An FCE can be used in the subacute, or maintenance phase of treatment. An FCE does not determine validity of injury but can reveal the effort a person expends to perform a task

Answer 98

(a) Disablement as defined by the World Health Organization is the term that summarizes all the effects of the injury or illness, impairments, activity limitations, and barriers to participation experienced by the individual. Workers receiving disability compensation have a disincentive to return to work. Reforms have been made to allow workers to investigate their ability to return to the work force without losing benefits. Disablement does not relate to advancement in the workplace.

Answer 99

(d) Risk factors for falling in the elderly include polypharmacy, particularly sedative use, cognitive impairment, lower extremity disability, palmomental reflex, foot problems, peripheral neuropathy and poor balance. DeLisa JA, Gans BM, editors

Answer 100

(b) During civil litigation, the physiatrist may be asked to comment on causality of an injury. The determination that 1 condition caused another condition should be determined on a “reasonable degree of medical certainty.” In this setting “probable” indicates that the physician believes there is a greater than 50% chance that condition A caused condition B. The term “possible” indicates that the physician believes there is a less than 50% chance that 1 event caused another condition.

Answer 101

(b) The DeLorme axiom states that high-weight, low-repetition exercises build strength and lowweight, high-repetition exercises build endurance. DeLateur BJ. Therapeutic exercise. In: Braddom RL, editor. Physical medicine and rehabilitation.

Answer 102

(c) Muscle energy technique is used to increase mobility of a hypomobile segment, increase functional range of motion, allow the return of symmetrical motion to affected segments, strengthen weakened muscles, and lengthen contracted or spastic muscles. It uses isometric contractions, not isotonic ones. It is not used for unstable segments, and does not improve proprioception or focus on facilitating volitional activity.

Answer 103

(b) Impairment is defined as an alteration of a person’s health status, a deviation from normal in a body part or any organ system (any loss or abnormality of psychologic, physiologic, or anatomic structure or function).

Answer 104

(a) An open kinetic chain occurs when the terminal segment is free to move. A closed kinetic chain occurs when the terminal segment is fixed. The hand during a biceps curl is free to move and represents an open kinetic chain.

Mod/Ex/Aging/Research SAEs Flashcards

(128 cards)